Innovative Community-Based Approaches Doubled Tuberculosis Case Notification and Improve Treatment Outcome in Southern Ethiopia

Abstract

BackgroundTB Control Programmes rely on passive case-finding to detect cases. TB notification remains low in Ethiopia despite major expansion of health services. Poor rural communities face many barriers to service access.Methods and FindingsA community-based intervention package was implemented in Sidama zone, Ethiopia. The package included advocacy, training, engaging stakeholders and communities and active case-finding by female Health Extension Workers (HEWs) at village level. HEWs conducted house-to-house visits, identified individuals with a cough for two or more weeks, with or without other symptoms, collected sputum, prepared smears and supervised treatment. Supervisors transported smears for microscopy, started treatment, screened contacts and initiated Isoniazid preventive therapy (IPT) for children. Outcomes were compared with the pre-implementation period and a control zone. Qualitative research was conducted to understand community and provider perceptions and experiences.HEWs screened 49,857 symptomatic individuals (60% women) from October 2010 to December 2011. 2,262 (4·5%) had smear-positive TB (53% women). Case notification increased from 64 to 127/100,000 population/year resulting in 5,090 PTB+ and 7,071 cases of all forms of TB. Of 8,005 contacts visited, 1,949 were symptomatic, 1,290 symptomatic were tested and 69 diagnosed with TB. 1,080 children received IPT. Treatment success for smear-positive TB increased from 77% to 93% and treatment default decreased from 11% to 3%. Service users and providers found the intervention package highly acceptable.ConclusionsCommunity-based interventions made TB diagnostic and treatment services more accessible to the poor, women, elderly and children, doubling the notification rate and improving treatment outcome. This approach could improve TB diagnosis and treatment in other high burden settings.

Understanding the investigators: a qualitative study investigating the barriers and enablers to the implementation of local investigator-initiated clinical trials in Ethiopia

“…However, it is important to emphasise that our description is not universal and individual examples of enabling practices and trial capacity exist. Furthermore, no information was available to us on the number of trial applications, rejections and turnaround times and although little local evidence-based practice was reported, this was not confirmed by the authorities and examples of local trials influencing policy are found in the literature 23. Nevertheless these results demonstrate the importance of taking a system-wide view to research development.…”

Intensified tuberculosis case finding amongst vulnerable communities in southern India

“…Community-based ICF interventions implemented elsewhere in India and other countries have shown similar results; this reflects the replicability and scalability of such interventions. [3][4][5] An intervention in Orissa, India, increased case detection by 11%. 3 A similar ICF activity conducted in Ethiopia doubled the pulmonary TB case notification rate, from 64 to 127/100 000 population/year.…”

“…3 A similar ICF activity conducted in Ethiopia doubled the pulmonary TB case notification rate, from 64 to 127/100 000 population/year. 4 In the results of the FIDELIS (Fund for Innovative DOTS Expansion through Local Initiatives to Stop TB) project in China, which massively mobilised school students for case finding, the case detection in intervention counties increased by a factor of 3.5 relative to the pre-intervention period. 5 There were some limitations to our study.…”

“…Alternatively, door-to-door counselling visits may lead to moderate behavioural change, help in case detection and be more cost-effective than special programmes or campaigns, as shown in Cambodia. 4 Future studies should assess the cost-effectiveness of such interventions to determine the optimal periodicity of such interventions before making scale-up decisions. Given these encouraging initial results and to address the above limitations, a larger study is being planned.…”

Tuberculosis Case Notification and Treatment Outcomes in West Gojjam Zone, Northwest Ethiopia: A Five-Year Retrospective Study

“…It was then subsequently scaled up nationwide and a 100% geographical and 92% health facility coverage were achieved [2]. Nonetheless, previous studies conducted in different regions of Ethiopia showed that the passive case finding approach, where TB patients self-report to health care facilities leaves significant number of undiagnosed TB cases in the community [5]- [9].…”